"We Knew the Need Was Significant": Nurse Leadership by Example

May 25, 2012, 1:00 PM

Partners Investing in Nursing’s Future (PIN), a partnership between the Robert Wood Johnson Foundation (RWJF) and the Northwest Health Foundation, devoted the latest issue of its PIN Point newsletter to the topic of leadership and featured the Leading Toward Tomorrow Project, which cultivates nurse leaders in southeast Michigan, with a primary focus on geriatric care. Below, three project leaders weigh in on what led them to tackle leadership development and what they’ve learned along the way.

Why does your organization see nursing leadership as an area worthy of investment?

Elizabeth Sullivan, MPA, vice president for community investment at the Community Foundation for Southeast Michigan: We felt it was important to build the nursing workforce and to do it in a way, in this particular project, that supports retention and mobility of nurses. We knew that the need was significant in southeast Michigan, and we knew it was important to do this with nurses in acute and long-term care settings. Our interest was working with novice nurses who found themselves in management positions and were working in care settings that serve a lot of older adults.

Carole Stacy, MA, MSN, RN, director of the Michigan Center for Nursing: On one of our nursing surveys several years ago, one of the questions was: If you’ve left a nursing job in the last two years, what was the reason? One of the answers they could select was that they had difficulty with their nurse manager or with administration. Over the course of several surveys, we kept seeing that particular response chosen in large numbers. Then we really started going out and looking at what the problem was. We found that in Michigan, we do not do a very good job of preparing people to be in nursing management. Just because they’re a good nurse, we assume they’ll have the skills needed to be a good manager. And that’s frequently not the case.

Nora Maloy, DrPH, senior program officer at the Blue Cross Blue Shield of Michigan Foundation: The Foundation has been supporting the profession of nursing since 2003, when we developed an initiative addressing the nursing shortage. That put us in touch with nurse leaders from around the state. Since then, through our nurse leader colleagues, we have seen the impact of nursing on all aspects of health care, including access, policy and quality of care.

What advice would you give to others looking at leadership development?

Sullivan: Find the right partner. The Community Foundation knew that the Robert Wood Johnson Foundation and the Northwest Health Foundation had this funding opportunity through PIN. We knew we had nursing workforce issues in southeast Michigan. And we knew that working with an older adult population was a significant issue for nurses in southeast Michigan. But we didn’t put those pieces together as “We need a nursing leadership development program.” It was going to the right partner, and our partner saying, “You know what? We’ve done some research, and we have a survey, and we think this is an approach that has merit.”

Maloy: I recommend that funders interested in leadership development get in touch with the state organization that has determined the need, stakeholders and strategy for leadership development. In the case of nurses here, it is the Michigan Center for Nursing.

What is the difference between a nurse leader and a nurse manager?

Maloy: A nurse leader leads at a macro level, whereas a nurse manager leads at a micro level.

Stacy: The thing that we try to get across is that every nurse is a leader, either in a formal or informal role. That’s a difficult idea for many nurses to grasp. Every nurse is an advocate, and being an advocate is a very important part of being a leader. They all advocate for their patients. I always say that if you’re in any kind of situation where you need to figure out what needs to be done, if you have about four nurses together, you can figure it out, because they are very action-oriented. One of the big things is getting all nurses to see themselves as having leadership qualities, and getting nurse managers to foster that in the people they’re working with.

What characteristics have you identified that can make a good nurse leader?

Stacy: People often think that to be a leader, you’re the one that has to come up with all the ideas. It’s important for us to show the people in our program that it’s not that they have to come up with all the ideas, but that they have to encourage creativity and innovation in the people they supervise and show them that their opinions and their work are valued.

Maloy: A nurse leader is able to see and speak on the 30,000-foot level, where he or she can see nursing as one component of many making up our health care industry.

How do you know that your training efforts have made a difference?

Stacy: We’re getting feedback from employers who are saying they’re amazed at the difference in the nurses. We had three nurses from one system, and their chief nursing officer called me after a meeting and said, “I have to tell you, these are three people who’ve never really spoken up before, and their hands were up all the time.” So it’s great to sense the excitement of them sharing what they’re learning and feeling more comfortable in a leadership role.

Maloy: I was fortunate enough to be asked to respond to the nurse-designed and -led projects required of all nurses taking part in our leadership development program. The quality and comprehensiveness of the projects was impressive. On that day, I realized we made a great investment.

What have you learned from your project that can be shared with others?

Sullivan: For the Community Foundation, the project has opened doors to addressing workforce needs in our community and caused us to look a little differently at health care. Health care funders focus largely on access to health care, and we’re looking at workforce issues, as well as programs that help build the availability of health care in the community. The other piece of it for the Community Foundation is the opportunity to work with a new partner, the Michigan Center for Nursing, which opens doors to state issues related to the nursing workforce and nursing education. It’s been incredibly educational, opening our eyes to issues that we had not been involved in before this effort.

Maloy: My salient take-away from co-funding this project is that nurses have an excellent perspective on acute and long-term care organizations. They have the knowledge and creative skills to identify problems and propose solutions.

Are there differences or similarities in nurse leadership development for acute and long-term care environments?

Sullivan: The need is there for both. One of the challenges is that it’s more difficult for long-term care facilities to release nurses for training. We need to get greater buy-in from the long-term care sector.

Stacy: Long-term care is a different environment to work in, and a lot of times, those nurses see themselves as second-class. They don’t feel equal to nurses who work in, say, acute care, coronary care or ICU. So we have the acute and long-term care nurses in the same group, because we want them to recognize the role that each of them plays in the care of patients. And they find that the problems they’re experiencing are the same. At some point, we may want to do something a little different for the long-term care nurses that’s geared toward the fact that they’re often working with staff who don’t have as high an educational level, whereas acute care nurses work more frequently with certified professionals.

Maloy: The basic knowledge regarding leadership development is the same for both acute and long-term care nurses. The application, however, differs due to a significantly different structure of patients, administration and staff.

Partners Investing in Nursing’s Future (PIN) is a partnership of the Northwest Health Foundation and the Robert Wood Johnson Foundation to support the capacity, involvement and leadership of local foundations to advance the nursing profession in their own communities. Learn more.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.